Figure Legends
Figure 1: Diagram of the anti-cancer mechanism of TTFields. (A) During metaphase mitosis, tubulin will align in the direction of the EF, resulting in interference with its polymerization and thus impaired chromosome segregation. (B) During cell division, the cell morphology under TTFields (hourglass-like shape) produces an inhomogeneous intracellular EF, and all polar macromolecules and organelles will be pushed towards the CCF. In addition to interfering with mitosis, TTFields has multiple biological mechanisms, including: (C)inhibiting DSB repair, enhancing DNA replication pressure, (D)inhibiting tumor cell migration and metastasis, (E) promoting autophagy, and (F) inflammatory responses to kill tumor cells,(G) increasing cell membrane and (H) BBB permeability to facilitate the uptake of agents.
Figure 2: Images before TTFields and during follow-up of a 73-year-old patient with GBM.Due to an immune thrombocytopenia, only TTFields was applied 4 weeks after completion of radiotherapy with concomitant TMZ. Before TTFields, baseline FET PET images showed a slight increase in metabolic activity (TBRmax 2.0, TBRmean 1.6) without spatial counterpart contrast enhancement. Sequential FET PET images at 3 and 6 months follow-up showed a decrease in metabolic activity, as evidenced by a decreased tumor-to-brain ratio. Compared to MRI T1 images, FET PET images showed clearer lesions. Adapted permission from [ ref. 91].
Table I: The summary of finished clinical studies of TTFields in brain tumors.